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    <title>遗传门诊咨询记录单（新筛）</title>
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        <span class="manageTitleText">遗传门诊咨询记录单（新筛）</span>
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    <div class="ibox float-e-margins">
        <div class="ibox-content floatClear">
            <div class="iboxTitle floatClear">
                <div class="iboxTitleBg">基础信息</div>
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                    导入
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                        <div class="basisLabel floatLeft">新筛编号：</div>
                        <div class="floatLeft">41256465746576</div>
                    </div>
                </div>
                <div class="basisList floatClear">
                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">母亲姓名：</div>
                        <div class="floatLeft">王芳芳</div>
                    </div>
                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">母亲年龄：</div>
                        <div class="floatLeft">25</div>
                    </div>
                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">父亲年龄：</div>
                        <div class="floatLeft">25</div>
                    </div>
                </div>
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                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">新生儿姓名：</div>
                        <div class="floatLeft">王芳芳</div>
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                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">新生儿性别：</div>
                        <div class="floatLeft">男</div>
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                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">出生日期：</div>
                        <div class="floatLeft">2019/2/21</div>
                    </div>
                </div>
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                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">身长：</div>
                        <div class="floatLeft">111CM</div>
                    </div>
                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">体重：</div>
                        <div class="floatLeft">21kg</div>
                    </div>
                    <div class="floatClear basisItem floatLeft">
                        <div class="basisLabel floatLeft">是否有同胞：</div>
                        <div class="floatLeft">否</div>
                    </div>
                </div>
                <div class="basisList floatClear">
                    <div class="floatClear basisItem floatLeft" style="width: auto;">
                        <div class="basisLabel floatLeft">42天体检情况：</div>
                        <div class="floatLeft" style="width: 11rem;">检测情况检测情况检测情况检测情况检测情况检测情况检测情况</div>
                    </div>
                </div>
            </div>
            <div class="iboxTitle floatClear">
                <div class="iboxTitleBg">受检者情况</div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.6rem;">喂养：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="muru" type="checkbox" class="i-checks" name="input[]">
                    <label for="muru">母乳</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="rengong" type="checkbox" class="i-checks" name="input[]">
                    <label for="rengong">人工</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="hunhe" type="checkbox" class="i-checks" name="input[]">
                    <label for="hunhe">混合</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <label for="">备注</label>
                    <input class="dnaInput" type="text" placeholder="点击填写备注">
                </div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.6rem;">疫苗接种情况：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="zhengc" type="checkbox" class="i-checks" name="input[]">
                    <label for="zhengc">正常</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="jiez" type="checkbox" class="i-checks" name="input[]">
                    <label for="jiez">未按时接种</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <label style="margin-left: 1.2rem;" for="">备注</label>
                    <input class="dnaInput" type="text" placeholder="点击填写备注">
                </div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">是否有就诊：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
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            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">其他临床表现：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
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                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;line-height: normal;">体格检查及实验室检查：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
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                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">家族史：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">孕产史：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="iboxTitle floatClear">
                <div class="iboxTitleBg">咨询内容</div>
            </div>
            <div class="floatClear dnaCheckBox recordCheckBox">
                <div class="dnaCheckRightBox floatLeft">
                    <input id="yic" type="checkbox" class="i-checks" name="input[]">
                    <label for="yic">遗传方式</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="zaifa" type="checkbox" class="i-checks" name="input[]">
                    <label for="zaifa">再发风险</label>
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                <div class="dnaCheckRightBox floatLeft">
                    <input id="jibin" type="checkbox" class="i-checks" name="input[]">
                    <label for="jibin">疾病表现</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="fabin" type="checkbox" class="i-checks" name="input[]">
                    <label for="fabin">发病年龄（随访时间）</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="zhiliao" type="checkbox" class="i-checks" name="input[]">
                    <label for="zhiliao">治疗及预后</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="waixian" type="checkbox" class="i-checks" name="input[]">
                    <label for="waixian">发病率和外显情况</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="xianzheng" type="checkbox" class="i-checks" name="input[]">
                    <label for="xianzheng">先证者兄弟姐妹是否会受影响</label>
                </div>
            </div>
            <div class="floatClear dnaCheckBox recordCheckBox">
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                    <input id="qita" type="checkbox" class="i-checks" name="input[]">
                    <label for="qita">其它问题</label>
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                <input class="dnaInput floatLeft" style="width: 9.22rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="iboxTitle floatClear">
                <div class="iboxTitleBg">父母信息</div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">学历（选择性透露）：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">获取英语信息能力：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="wu" type="checkbox" class="i-checks" name="input[]">
                    <label for="wu">无</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="yib" type="checkbox" class="i-checks" name="input[]">
                    <label for="yib">一般 </label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="zhuanye" type="checkbox" class="i-checks" name="input[]">
                    <label for="zhuanye">专业</label>
                </div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">父母焦虑程度 ：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="bujiaolv" type="checkbox" class="i-checks" name="input[]">
                    <label for="bujiaolv">不焦虑 </label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="yib1" type="checkbox" class="i-checks" name="input[]">
                    <label for="yib1">一般 </label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="feicjiaolv" type="checkbox" class="i-checks" name="input[]">
                    <label for="feicjiaolv">非常焦虑</label>
                </div>
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            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">是否高危职业 ：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="yes" type="checkbox" class="i-checks" name="input[]">
                    <label for="yes">是</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="fo" type="checkbox" class="i-checks" name="input[]">
                    <label for="fo">否</label>
                </div>
                <input class="dnaInput floatLeft" style="width: 6.62rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;line-height: normal;">对于遗传学知识的了解程度：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="buliaojie" type="checkbox" class="i-checks" name="input[]">
                    <label for="buliaojie">不了解</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="jiandan" type="checkbox" class="i-checks" name="input[]">
                    <label for="jiandan">简单了解</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="feichanglieojie" type="checkbox" class="i-checks" name="input[]">
                    <label for="feichanglieojie">非常了解</label>
                </div>
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            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;line-height: normal;">是否通过百度等公共网站了解疾病  ：</div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="yes2" type="checkbox" class="i-checks" name="input[]">
                    <label for="yes2">是</label>
                </div>
                <div class="dnaCheckRightBox floatLeft">
                    <input id="fo2" type="checkbox" class="i-checks" name="input[]">
                    <label for="fo2">否</label>
                </div>
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">备注：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
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                <div class="iboxTitleBg">咨询建议</div>
            </div>
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                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">咨询建议：</div>
                <input class="dnaInput floatLeft" style="width: 8.98rem;margin: 0;" type="text" placeholder="点击填写备注">
            </div>
            <div class="floatClear dnaCheckBox">
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;">咨询师：</div>
                <select class="dnaSelect floatLeft" name="" id="">
                    <option value="">请选择</option>
                </select>
                <div class="dnaCheckLabel floatLeft" style="width: 1.7rem;text-align: right;">咨询时间：</div>
                <input class="dnaInput floatLeft" style="width: 3.65rem;margin: 0;" type="text" placeholder="选择时间"
                       onclick="laydate({istime: true, format: 'YYYY-MM-DD'})">
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